1
|
Barnett NR, George RM, Hatter KH, Janosy NR, Vizzini SJ, Singh S, Lee RE, Wolf BJ, Cabrera C, Duhachek-Stapelman AL, Katz D. Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician-gynecologists. J Matern Fetal Neonatal Med 2024; 37:2311072. [PMID: 38326280 DOI: 10.1080/14767058.2024.2311072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN). METHODS A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models. RESULTS The survey was distributed to 556 anesthesiology and 662 obstetrics-gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician-gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001). CONCLUSIONS ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.
Collapse
Affiliation(s)
- Natalie R Barnett
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Renuka M George
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine H Hatter
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Norah R Janosy
- Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Samantha J Vizzini
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Shubhangi Singh
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca E Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Camila Cabrera
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
2
|
Fernandez-Pineda M, Swift A, Dolbier C, Banasiewicz KG. Compounding stress: A mixed-methods study on the psychological experience of miscarriage amid the COVID-19 pandemic. BMC Pregnancy Childbirth 2024; 24:426. [PMID: 38872085 PMCID: PMC11170813 DOI: 10.1186/s12884-024-06610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Experiencing a miscarriage can have profound psychological implications, and the added strain of the COVID-19 pandemic may have compounded these effects. This study aimed to explore the psychological experiences, assess the levels of psychological distress (depression, anxiety, and post-traumatic stress disorder), and examine the relationships of personal significance of miscarriage and perceived stress with psychological distress of women in North Carolina who suffered a miscarriage of a desired pregnancy between March 30, 2020, and February 24, 2021, of the COVID-19 pandemic, at 14 to 31 months after the loss. METHODS We conducted a cross-sectional mixed-methods study using a convergent parallel design. A total of 71 participants from North Carolina completed the online survey and 18 completed in-depth interviews. The survey assessed demographics, mental health and reproductive history, personal significance of miscarriage, perceived stress, anxiety, depression, and PTSD. Interview questions asked about the psychological experience of the miscarriage and how the COVID-19 pandemic affected them and their experience. RESULTS Findings indicated moderate to severe levels of depression, anxiety, and PTSD, which persisted 14 to 31 months post-miscarriage. After conducting hierarchical binary logistic regressions, we found that perceived stress and prior trauma increased the odds of depression, perceived stress increased the odds of anxiety, and personal significance and prior trauma increased the odds of PTSD symptoms 14-31 months post-miscarriage. Notably, a subsequent successful childbirth emerged as a protective factor against depression, anxiety, and PTSD. Qualitative findings depicted emotions such as profound isolation, guilt, and grief. Women noted that additional pandemic-specific stressors exacerbated their distress. The categories identified via conventional content analysis fell under five broader thematic groups: mental health disorders, negative emotions/feelings, positive emotions/feelings, thoughts, and other experiences. CONCLUSIONS Miscarriage during the COVID-19 pandemic intensified and added complexity to the psychological distress experienced by affected women. The study underscores the need for comprehensive mental health screenings, specialized support for vulnerable groups, and the necessity of trauma-informed care. Providers are strongly encouraged to adopt a multifaceted, individualized approach to patient care that is cognizant of the unique stressors introduced by the pandemic.
Collapse
Affiliation(s)
- Madeline Fernandez-Pineda
- College of Nursing, Department of Nursing Science, East Carolina University, 2205 W 5th St, Greenville, NC, 27834, USA.
| | - Alison Swift
- College of Nursing, Department of Advanced Nursing Practice and Education, East Carolina University, 2205 W 5th St, Greenville, NC, 27834, USA
| | - Christyn Dolbier
- Department of Psychology, East Carolina University, Thomas Harriot College of Arts and Sciences, 104 Rawl Building, Greenville, NC, 27858, USA
| | | |
Collapse
|
3
|
Adeleye KK, Ogungbe O, Chutiyami M, Iradukunda F. Pregnancy loss among Muslim women: A narrative review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100205. [PMID: 38827821 PMCID: PMC11141144 DOI: 10.1016/j.ijnsa.2024.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Background Diversity in spirituality, religion, and cultural norms among women leads to varying attitudes, grieving processes, and coping mechanisms after a pregnancy loss. Despite this, there is a limited understanding of grief, coping mechanisms, and mental health outcomes following pregnancy loss among Muslim women. Objectives This study aims to examine the impact of religion, spirituality, and faith communities on the psychological health of Muslim women during pregnancy loss. Method We systematically searched six databases with the key concepts, 'pregnancy loss' and 'Muslim women,' in PubMed, CINAHL, Embase, Web of Science, APA PsycINFO, and Academic Search. The search strategy was developed in line with the PCOT framework: Population - Muslim Women with "pregnancy loss," "miscarriage," "stillbirth, Context - "religion," faith, "spirituality," "faith communities," Outcome - "religious practices," perception, coping mechanism, "psychological health."Studies were screened, their quality appraised, and narratively sized in line with the review aim. The review protocol was registered at Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/52QTA. Result Findings from the reviewed articles addressed the following themes: (a) Overwhelming Grief and Loss, (b) social isolation and stigmatization, (c) impact on mental health, and (d) trust in divine destiny. Islamic beliefs were strongly featured in how Muslim women processed pregnancy loss. Concepts such as tawakkul and yaqeen (trusting and certainty) were used to interpret pregnancy loss, with many women acknowledging that their Islamic faith eased the sorrow of pregnancy loss, facilitated acceptance, and strengthened their Islamic belief system. Conclusion This review revealed that there is limited information on Muslim women's experience of pregnancy loss. Professionals helping Muslim women dealing with the grief of pregnancy loss need to be aware that spirituality and faith communities play a major role in shaping their coping mechanisms. Future studies on the development of culturally congruent bereavement care models and supportive interventions for Muslim women facing pregnancy loss.
Collapse
Affiliation(s)
- Khadijat K. Adeleye
- Elaine Marieb College of Nursing University of Massachusetts, Amherst, United States
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Muhammad Chutiyami
- School of Nursing and Midwifery, University of Technology Sydney, Australia
| | - Favorite Iradukunda
- Elaine Marieb College of Nursing University of Massachusetts, Amherst, United States
| |
Collapse
|
4
|
Beringer S, Milewski N. A crisis in the life course? Pregnancy loss impacts fertility desires and intentions. ADVANCES IN LIFE COURSE RESEARCH 2024; 60:100612. [PMID: 38762969 DOI: 10.1016/j.alcr.2024.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND An unintended spontaneous termination of a pregnancy can be a traumatic experience affecting the subsequent life course, but has received little attention in socio-demographic studies on fertility intentions or behavior. The theoretical background of our study draws on considerations from life course research, the Theory of Planned Behavior and the Traits-Desires-Intentions-Behavior framework. OBJECTIVE This study investigates whether the experience of pregnancy loss changes the fertility desires and intentions of women in their subsequent life course. METHODS We use 11 waves of the Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) with 5197 women in total, of which 281 women (5.4%) reported a miscarriage. Data have been collected annually in Germany since 2008. We investigate four dependent variables capturing different indicators of the ideational dimension of fertility: Personal ideal number of children, realistic number of (additional) children, intention to have a(nother) child in the next two years and importance of having a(nother) child. We study the intrapersonal changes in these items among women after a pregnancy loss, applying linear fixed effect regression models. Controls include parity, age, partnership status, pregnancy status and the interaction of pregnancy loss with whether the woman already had children before the pregnancy loss. RESULTS We found that the importance of having a(nother) child and the intention to have a(nother) child in the next two years increase after a pregnancy loss. These patterns can only partially be explained by control variables. By contrast, an effect on the ideal number of children as well as the realistic number of children could not be found. The patterns varied, however, across age and stage in the life course, most importantly between mothers and childless women. CONCLUSIONS Our results demonstrate that the effect of pregnancy loss on the subsequent life course varies across the indicators used and by duration after the pregnancy loss. Overall, they suggest that specifically the younger women in our sample might perceive pregnancy loss as a temporary crisis in their transition to motherhood, or to having another child, and as an impetus to reinforce their fertility goals, while for older respondents this might mark the end of their fertility career. Against the backdrop of rising ages at childbirth, future research on fertility and reproductive health care should pay more attention to reproductive complications and how affected women can be supported in coping with them.
Collapse
Affiliation(s)
- Samira Beringer
- Federal Institute for Population Research (BiB), Wiesbaden, Germany.
| | - Nadja Milewski
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| |
Collapse
|
5
|
Combellick JL, Esmaeili A, Johnson AM, Haskell SG, Phibbs CS, Manzo L, Miller LJ. Perinatal mental health and pregnancy-associated mortality: opportunities for change. Arch Womens Ment Health 2024; 27:417-424. [PMID: 38172275 DOI: 10.1007/s00737-023-01404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
Perinatal mental health conditions have been associated with adverse pregnancy outcomes, including maternal death. This quality improvement project analyzed pregnancy-associated death among veterans with mental health conditions in order to identify opportunities to improve healthcare and reduce maternal deaths. Pregnancy-associated deaths among veterans using Veterans Health Administration (VHA) maternity care benefits between fiscal year 2011 and 2020 were identified from national VHA databases. Deaths among individuals with active mental health conditions underwent individual chart review using a standardized abstraction template adapted from the Centers for Disease Control and Prevention (CDC). Thirty-two pregnancy-associated deaths were identified among 39,720 paid deliveries with 81% (n = 26) occurring among individuals with an active perinatal mental health condition. In the perinatal mental health cohort, most deaths (n = 16, 62%) occurred in the late postpartum period and 42% (n = 11) were due to suicide, homicide, or overdose. Opportunities to improve care included addressing (1) racial disparities, (2) mental health effects of perinatal loss, (3) late postpartum vulnerability, (4) lack of psychotropic medication continuity, (5) mental health conditions in intimate partners, (6) child custody loss, (7) lack of patient education or stigmatizing patient education, and (8) missed opportunities for addressing reproductive health concerns in mental health contexts. Pregnancy-associated deaths related to active perinatal mental health conditions can be reduced. Mental healthcare clinicians, clinical teams, and healthcare systems have opportunities to improve care for individuals with perinatal mental health conditions.
Collapse
Affiliation(s)
- Joan L Combellick
- Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA.
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, 795 Willow Road, Menlo Park, Palo Alto, CA, 94025, USA
| | - Amanda M Johnson
- Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA
| | - Sally G Haskell
- Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT, 06510, USA
| | - Ciaran S Phibbs
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, 795 Willow Road, Menlo Park, Palo Alto, CA, 94025, USA
- Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Laura Manzo
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA
- US Army, AMEDD Student Detachment, 187th Medical Battalion, Joint Base San Antonio, San Antonio, TX, 78234, USA
| | - Laura J Miller
- Department of Veterans Affairs, Veterans Health Administration, Women's Mental Health, Office of Mental Health and Suicide Prevention, 810 Vermont Ave NW, Washington, DC, 20420, USA
- Department of Psychiatry and Behavioral Sciences, Stritch School of Medicine, Loyola University, 2160 South First Avenue, Maywood, IL, 60153, USA
| |
Collapse
|
6
|
Küçük Öztürk G, Elmas S. "The Dark Farewell to the Light of Life": A Qualitative Study About Prenatal Loss. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:21-38. [PMID: 36179368 DOI: 10.1177/00302228221131599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM This study was conducted to determine the experiences of women who encountered loss in the prenatal period. METHOD This study was a qualitative study conducted using the phenomenological method and was conducted according to the guidelines of the COREQ checklist. A total of 11 women who were experienced loss in the early prenatal period were interviewed. The data were analyzed using the content analysis. RESULTS Three main themes and eight sub-themes emerged. The themes were light of life (bubble of happiness, journey), dark farewell (silent scream inside, unfinished tale: motherhood, loneliness, family approach) and obscurity (uncertainty about the future, need for support). Women expressed that the loss process had negative effects on their mental health and that they needed help. CONCLUSION Pregnancy illuminates women's lives, while prenatal loss involves intense and various negative emotions, and women need support in many ways. These results show that women who experienced loss in the prenatal period should be allowed to express their feelings, thoughts and experiences, and the risks in terms of mental health should be reduced by supporting them during the loss and mourning process.
Collapse
Affiliation(s)
- Gülhan Küçük Öztürk
- Department of Psychiatric Nursing, Nevşehir Hacı Bektaş Veli UniversitySemra and Vefa Küçük Faculty of Health Sciences, Nevşehir, Turkey
| | - Semra Elmas
- Department of Nursing, School of Health, European University of Lefke, Lefke, Northern Cyprus
| |
Collapse
|
7
|
Conroy C, Jain T, Lin T, Mody SK. Assessing Interest in a Peer Support Person for Patients Experiencing Early Pregnancy Loss: Results from a National Survey. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:268-275. [PMID: 38558947 PMCID: PMC10979676 DOI: 10.1089/whr.2023.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 04/04/2024]
Abstract
Introduction The use of a peer support person as an intervention for early pregnancy loss (EPL) is not well studied. In addition, limited literature exists regarding the type of support patients need when experiencing EPL. The objective of this study is to quantify interest in a peer EPL support person intervention, to assess the types of support desired following EPL, and to investigate if there is an association between self-compassion or resilience and coping ability post-EPL. Methods We conducted a cross-sectional, web-based survey with 110 individuals who experienced EPL in the past 2 years. Questions explored interest in a peer EPL support person and different types of support, as well as perceived self-compassion and resilience. Analyses of variance were used to test if interest in the peer support intervention and in different types of support varied by demographics, while linear regression modeling was used to test the relationship between self-compassion, resilience, and coping ability. Results Nearly all participants (98.2%, n = 108) were interested in peer support. The majority (31.8%, n = 35) of participants prioritized informational and educational support at the time of their EPL and in the months following. There was a positive relationship between self-compassion scores and ability to cope with EPL (p = 0.2) and between resilience scores and coping ability (p < 0.05). Conclusions Almost all participants were interested in a peer support person for coping with EPL. Given the types of support participants identified in this study, a peer support person may provide emotional and informational support as well as resilience training.
Collapse
Affiliation(s)
- Carmen Conroy
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Tanya Jain
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Tuo Lin
- Department of Biostatistics, University of California San Diego, San Diego, California, USA
| | - Sheila K. Mody
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California, USA
| |
Collapse
|
8
|
Shen Q, Zhong W, Wang X, Fu Q, Mao C. Associations between pregnancy loss and common mental disorders in women: a large prospective cohort study. Front Psychiatry 2024; 15:1326894. [PMID: 38525260 PMCID: PMC10957736 DOI: 10.3389/fpsyt.2024.1326894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Background Increasing evidence suggests that pregnancy loss can lead to negative emotional outcomes, such as anxiety and depression, for women. However, limited knowledge exists regarding the long-term risk of mental disorders among individuals who have experienced pregnancy loss. Objective To investigate the associations between pregnancy loss and the risk of common mental disorders. Methods In the UK Biobank, a total of 218,990 women without any mental disorder at baseline were enrolled between 2006 and 2010 and followed until October 2022. Information on the history of pregnancy loss was obtained through self-reported questionnaires at baseline. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between pregnancy loss and common mental disorders. Results During a median follow-up time of 13.36 years, there were 26,930 incident cases of common mental disorders. Incidence rates of common mental disorders were elevated among women with a history of stillbirth (HR 1.15, 95% CI: 1.07-1.23), miscarriage (HR 1.06, 95% CI: 1.02-1.10), or pregnancy termination (HR 1.21, 95% CI: 1.17-1.25) compared to those without such experiences. Furthermore, the risk of common mental disorders significantly increased in women with two or more miscarriages (HR 1.14, 95% CI: 1.08-1.19) or two or more pregnancy terminations (HR 1.39, 95% CI: 1.30-1.48). Conclusions Pregnancy loss is associated with an increased risk of common mental disorders in women later in life. These findings may contribute to the enhancement of long-term monitoring and prevention of common mental disorders for women with such a history.
Collapse
Affiliation(s)
- Qiaoqiao Shen
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenfang Zhong
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaomeng Wang
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Qi Fu
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Chen Mao
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
9
|
Kyriacou C, Kapur S, Jeyapala S, Parker N, Yang W, Pikovsky M, Bobdiwala S, Barcroft J, Maheetharan S, Sur S, Stalder C, Gould D, Syed S, Tan T, Bourne T. Beta-human chorionic gonadotrophin point of care testing for the management of pregnancy of unknown location. Reprod Biomed Online 2024; 48:103643. [PMID: 38262209 DOI: 10.1016/j.rbmo.2023.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Abstract
RESEARCH QUESTION Does a commercially available quantitative beta-human chorionic gonadotrophin (BHCG) point of care testing (POCT) device improve workflow management in early pregnancy by performing comparably to gold standard laboratory methods, and is the performance of a validated pregnancy of unknown location (PUL) triage strategy maintained using POCT BHCG results? DESIGN Women classified with a PUL between 2018 and 2021 at three early pregnancy units were included. The linear relationship of untreated whole-blood POCT and serum laboratory BHCG values was defined using coefficients and regression. Paired serial BHCG values were then incorporated into the validated M6 multinomial logistic regression model to stratify the PUL as at high risk or at low risk of clinical complications. The sensitivity and negative predictive value were assessed. The timings required for equivocal POCT and laboratory care pathways were compared. RESULTS A total of 462 PUL were included. The discrepancy between 571 laboratory and POCT BHCG values was -5.2% (-6.2 IU/l), with a correlation coefficient of 0.96. The 133 PUL with paired 0 and 48 h BHCG values were compared using the M6 model. The sensitivity for high-risk outcomes (96.2%) and negative predictive values (98.5%) was excellent for both. Sample receipt and laboratory processing took 135 min (421 timings), compared with 12 min (91 timings) when using POCT (P < 0.0001). CONCLUSIONS POCT BHCG values correlated well with laboratory testing measurements. The M6 model retained its performance when using POCT BHCG values. Using the model with POCT may improve workflow and patient care without compromising on effective PUL triage.
Collapse
Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Sobanakumari Jeyapala
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shabana Syed
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Tricia Tan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| |
Collapse
|
10
|
Kovacs P, Sun S, Lu Y, Romanski P, Lindheim SR. Benefits of Blastocyst Transfer With at Least Three Good-Quality Cleavage-stage Embryos in Women of Advanced Maternal Age: A Retrospective Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102233. [PMID: 37820927 DOI: 10.1016/j.jogc.2023.102233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Limited studies on the benefits of blastocyst transfer in advanced maternal age (AMA) (≥40 years) have been reported. Our objective was to find whether blastocyst-stage embryo transfer improves pregnancy and live birth rates in women ≥40 years who have 3 or more good-quality cleavage-stage embryos. METHODS All fresh in vitro fertilization-intracytoplasmic sperm injection cycles performed from January 2020 to December 2021 in AMA women that progressed to transfer were considered for analysis. We compared fresh and cumulative ongoing pregnancy rates in AMA women of those who had a cleavage-stage transfer, while meeting the criteria for extended culture (≥3 high-quality embryos, group 1), and those who underwent blastocyst transfer (group 2). Demographic parameters, stimulation, embryology, fresh and cumulative ongoing pregnancy rates, and clinical miscarriage rates were compared. RESULTS During the study period, 255 cycles were analyzed including group 1 (n = 99) and group 2 (n = 156). Group 1 participants were older and had a greater number of embryos for transfer. Fresh and cumulative ongoing pregnancy rates per transfer were higher in group 2 compared to group 1 (23.4% vs. 13.1%, P = 0.04; 25.5% vs. 14.1%, P = 0.03), while overall miscarriage rates were higher in group 1 than group 2 (51.7% vs. 25%, P = 0.01). CONCLUSIONS Blastocyst culture provides a benefit to AMA women who have at least 3 good-quality embryos on day 3 resulting in significantly higher fresh and cumulative ongoing pregnancy rates and lower miscarriage compared to cleavage-stage transfers.
Collapse
Affiliation(s)
| | - Samantha Sun
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Yao Lu
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | | | - Steven R Lindheim
- University of Central Florida College of Medicine, Orlando, Florida, USA; Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China; Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| |
Collapse
|
11
|
Giannatiempo F, Hollins Martin C, Patterson J, Welsh N. Exploring parents' experiences and holistic needs following late miscarriage: a narrative systematic review. J Reprod Infant Psychol 2024:1-26. [PMID: 38184816 DOI: 10.1080/02646838.2023.2297905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Up to 2% of all pregnancies result in pregnancy loss between 14 + 0 and 23 + 6 weeks' gestation, which is defined as 'late miscarriage'. Lack of consensus about definition of viability paired with existing multiple definitions of perinatal loss make it difficult to define the term 'late miscarriage'. Parents who experience late miscarriage often have had reassuring scan-milestones, which established their confidence in healthy pregnancy progression and identity formation, which socially integrates their baby into their family. The clinical lexicon alongside the lack of support offered to parents experiencing late miscarriage may disclaim their needs, which has potential to cause adverse psychological responses. AIM To review what primary research reports about parents' experiences and their perceived holistic needs following late miscarriage. METHODS A narrative systematic review was carried out. Papers were screened based on gestational age at time of loss (i.e. between 14 + 0 and 23 + 6 weeks' gestation). The focus was set on experience and holistic needs arising from the loss rather than its clinical care and pathophysiology. Studies were selected using PRISMA-S checklist, and quality assessed using the Critical Appraisal Skills Program (CASP) tool. Thematic analysis was used to guide the narrative synthesis of findings. RESULTS Six studies met the inclusion criteria. Three main themes emerged: communication and information-giving; feelings post-event; and impact of support provision. CONCLUSION Literature about the experience of late miscarriage is scarce, with what was found reporting a lack of compassionate and individually tailored psychological follow-up care for parents following late miscarriage. Hence, more research in this arena is required to inform and develop this area of maternity care provision.
Collapse
Affiliation(s)
- Francesca Giannatiempo
- School of Health and Social Care, Edinburgh Napier University (ENU), Edinburgh, Scotland, UK
| | - Caroline Hollins Martin
- School of Health and Social Care, Edinburgh Napier University (ENU), Edinburgh, Scotland, UK
| | - Jenny Patterson
- School of Health and Social Care, Edinburgh Napier University (ENU), Edinburgh, Scotland, UK
| | | |
Collapse
|
12
|
Balaguer N, Rodrigo L, Mateu-Brull E, Campos-Galindo I, Castellón JA, Al-Asmar N, Rubio C, Milán M. Non-invasive cell-free DNA-based approach for the diagnosis of clinical miscarriage: A retrospective study. BJOG 2024; 131:213-221. [PMID: 37533357 DOI: 10.1111/1471-0528.17629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To evaluate cell-free DNA (cfDNA) testing as a non-invasive approach to detecting aneuploidies in clinical miscarriages. DESIGN A retrospective cohort study of women with pregnancy loss. SETTING Hospitals and genetic analysis laboratories. POPULATION OR SAMPLE Pregnancy losses in the period 2021-2022. METHODS Results derived from non-invasive cfDNA testing (Veriseq NIPT Solution V2) of maternal blood and invasive analysis of products of conception (POC) (Ion ReproSeq) compared in 120 women who suffered a miscarriage. MAIN OUTCOME MEASURES Concordance rate results, cfDNA testing performance, non-informative rate (NIR) and fetal fraction (FF). RESULTS We found no significant differences in the NIR between invasive (iPOC) and non-invasive (niPOC) analysis of POC (10.0% [12/120] versus 16.7% [20/120]). Of 120 samples, 90 provided an informative result in iPOC and niPOC groups (75%). cfDNA analysis correctly identified 74/87 (85.1%) samples (excluding triploidies). Sensitivity and specificity were 79.4% and 100%, respectively; all discordant cases were female. A binomial logistic model suggested fetal sex as the only variable influencing the concordance rate (P = 0.035). A Y-chromosome-based FF estimate allowed the optimal reclassification of cfDNA of non-informative male fetuses and a more accurate evaluation of cfDNA testing performance. The difference between the two FF estimates (native algorithm and Y-chromosome-based) suggests that female non-concordant cases may represent non-informative cases. CONCLUSIONS Cell-free DNA-based testing provides a non-invasive approach to determining the genetic cause of clinical miscarriage.
Collapse
Affiliation(s)
- Nuria Balaguer
- Prenatal Diagnosis Department, Igenomix Spain Lab S.L.U., Paterna, Spain
| | - Lorena Rodrigo
- Preimplantation Genetic Testing for Aneuploidies (PGT-A) Department, Igenomix Spain Lab S.L.U., Paterna, Spain
| | - Emilia Mateu-Brull
- Prenatal Diagnosis Department, Igenomix Spain Lab S.L.U., Paterna, Spain
| | - Inmaculada Campos-Galindo
- Preimplantation Genetic Testing for Aneuploidies (PGT-A) Department, Igenomix Spain Lab S.L.U., Paterna, Spain
| | | | | | - Carmen Rubio
- Research and Development Department, Igenomix Spain Lab S.L.U., Paterna, Spain
| | - Miguel Milán
- Prenatal Diagnosis Department, Igenomix Spain Lab S.L.U., Paterna, Spain
| |
Collapse
|
13
|
Mergl R, Quaatz SM, Lemke V, Allgaier AK. Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths - A systematic review. J Psychiatr Res 2024; 169:84-96. [PMID: 38006823 DOI: 10.1016/j.jpsychires.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Women who have had miscarriages or stillbirths are known to have an elevated risk for depression. However, the prevalence of depressive disorders and/or symptoms in this group is unclear. Therefore, our aim was to estimate the corresponding prevalence of depression and depressive symptoms. A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 2022 in English or German on the prevalence of depression or depressive symptoms in women following miscarriages or stillbirths. Studies using valid psychiatric diagnoses or validated assessment methods regarding depression were included in the systematic review. The PRISMA guidelines were followed. Data concerning depressive symptoms were extracted from 14 studies. The range regarding prevalence of depressive symptoms in women with previous miscarriages or stillbirths was very wide (5%-91.2%). All longitudinal studies demonstrate a reduction of depressive symptoms over time. The prevalence of depressive disorders had a range of 5.4 (only for minor depression according to DSM-IV) - 18.6% (for depressive disorders according to ICD-10). The included studies are very heterogeneous considering the investigated groups, the length of pregnancies and time passed since the occurrence of miscarriages or stillbirths. Women with miscarriages or stillbirths have an elevated risk for depressive symptoms and disorders. In most affected women, depressive symptoms are most pronounced in the first months after the pregnancy loss and diminish over time.
Collapse
Affiliation(s)
- Roland Mergl
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| | - Sarah M Quaatz
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| | - Vanessa Lemke
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| | - Antje-Kathrin Allgaier
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| |
Collapse
|
14
|
Fetene SM, Haile TG, Dadi A. Effect of adverse perinatal outcomes on postpartum maternal mental health in low-income and middle-income countries: a protocol for systematic review. BMJ Open 2023; 13:e074447. [PMID: 38101849 PMCID: PMC10729045 DOI: 10.1136/bmjopen-2023-074447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION More than three-fourths of adverse perinatal outcomes (preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death) occur in low-income and middle-income countries. These adverse perinatal outcomes can have both short-term and long-term consequences on maternal mental health. Even though there are few empirical studies on the effect of perinatal loss on maternal mental illness, comprehensive information on the impact of adverse perinatal outcomes in resource-limited settings is scarce. Therefore, we aim to systematically review and synthesise evidence on the effect of adverse perinatal outcomes on maternal mental health. METHODS AND ANALYSIS The primary outcome of our review will be postpartum maternal mental illness (anxiety, depression, post-traumatic stress disorder and postpartum psychosis) following adverse perinatal outcomes. All peer-reviewed primary studies published in English will be retrieved from databases: PubMed, MEDLINE, CINAHL Ultimate (EBSCO), PsycINFO, Embase, Scopus and Global Health through the three main searching terms-adverse perinatal outcomes, maternal mental illness and settings, with a variant of subject headings and keywords. We will follow the Joanna Briggs Institute critical appraisal checklist to assess the quality of the studies we are including. The review findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Estimate-based meta-analysis will be performed. We will assess heterogeneity between studies using the I2 statistics and publication bias will be checked using funnel plots and Egger's test. A subgroup analysis will be conducted to explore potential sources of heterogeneity (if available). Finally, the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Since this systematic review does not involve human participants, ethical approval is not required. The review will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023405980.
Collapse
Affiliation(s)
| | | | - Abel Dadi
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
15
|
Sun X, Feng Y, Ma Q, Wang Y, Ma F. Protein glycosylation: bridging maternal-fetal crosstalk during embryo implantation†. Biol Reprod 2023; 109:785-798. [PMID: 37658761 DOI: 10.1093/biolre/ioad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
Infertility is a challenging health problem that affects 8-15% of couples worldwide. Establishing pregnancy requires successful embryo implantation, but about 85% of unsuccessful pregnancies are due to embryo implantation failure or loss soon after. Factors crucial for successful implantation include invasive blastocysts, receptive endometrium, invasion of trophoblast cells, and regulation of immune tolerance at the maternal-fetal interface. Maternal-fetal crosstalk, which relies heavily on protein-protein interactions, is a critical factor in implantation that involves multiple cellular communication and molecular pathways. Glycosylation, a protein modification process, is closely related to cell growth, adhesion, transport, signal transduction, and recognition. Protein glycosylation plays a crucial role in maternal-fetal crosstalk and can be divided into N-glycosylation and O-glycosylation, which are often terminated by sialylation or fucosylation. This review article examines the role of protein glycosylation in maternal-fetal crosstalk based on two transcriptome datasets from the GEO database (GSE139087 and GSE113790) and existing research, particularly in the context of the mechanism of protein glycosylation and embryo implantation. Dysregulation of protein glycosylation can lead to adverse pregnancy outcomes, such as missed abortion and recurrent spontaneous abortion, underscoring the importance of a thorough understanding of protein glycosylation in the diagnosis and treatment of female reproductive disorders. This knowledge could have significant clinical implications, leading to the development of more effective diagnostic and therapeutic approaches for these conditions.
Collapse
Affiliation(s)
- Xinrui Sun
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Feng
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qianhong Ma
- Department of Obstetrics/Gynecology, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Ma
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
16
|
Petersen JF, Friis-Hansen LJ, Bryndorf T, Jensen AK, Andersen AN, Løkkegaard E. A Novel Approach to Predicting Early Pregnancy Outcomes Dynamically in a Prospective Cohort Using Repeated Ultrasound and Serum Biomarkers. Reprod Sci 2023; 30:3597-3609. [PMID: 37640889 PMCID: PMC10692000 DOI: 10.1007/s43032-023-01323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
This study aimed to develop a dynamic model for predicting outcome during the first trimester of pregnancy using baseline demographic data and serially collected blood samples and transvaginal sonographies. A prospective cohort of 203 unselected women with an assumed healthy pregnancy of < 8 weeks' gestation was followed fortnightly from 4-14 weeks' gestation until either miscarriage or confirmed first trimester viability. The main outcome was development of a model to predict outcome from gestational age-dependent hazard ratios using both baseline and updated serial data from each visit. Secondary outcomes were descriptions of risk factors for miscarriage. The results showed that 18% of the women experienced miscarriages. A fetal heart rate detected before 8 weeks' gestation indicated a 90% (95% CI 85-95%) chance of subsequent delivery. Maternal age (≥ 35 years), insufficient crown-rump-length (CRL) and mean gestational sac diameter (MSD) development, and presence of bleeding increased the risk of miscarriage. Serum biomarkers, including hCG, progesterone, and estradiol, were found to impact the risk of miscarriage with estradiol as the most important. The best model to predict miscarriage was a combination of maternal age, vaginal bleeding, CRL, and hCG. The second-best model was the sonography-absent model of maternal age, bleeding, hCG, and estradiol. This study suggests that combining maternal age, and evolving data from hCG, estradiol, CRL, and bleeding could be used to predict fetal outcome during the first trimester of pregnancy.Trial registration ClinicalTrials.gov identifier: NCT02761772.
Collapse
Affiliation(s)
| | | | - Thue Bryndorf
- Gynecological Clinic, 10, 3, Ny Østergade, 1101, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
| | - Anders Nyboe Andersen
- The Fertility Clinic 4071, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Obstetrics and Gynecology, North Zealand Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
17
|
Tenório PJ, Katz L, Amorim MMR. Symptoms of anxiety and depression in women with gestational trophoblastic disease compared to women who had a miscarriage: a cross-sectional study. J Psychosom Obstet Gynaecol 2023; 44:2210747. [PMID: 37256828 DOI: 10.1080/0167482x.2023.2210747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/10/2023] [Accepted: 05/01/2023] [Indexed: 06/02/2023] Open
Abstract
This study was conducted between March 2020 and February 2021 to analyze anxiety and depression symptoms in 64 women with gestational trophoblastic disease (GTD) and 99 women who had miscarried. The Hospital Anxiety and Depression Scale (HADS) was applied by telephone three months after pregnancy loss. Multivariate analysis was performed using hierarchical logistic regression to evaluate associations between variables. Probable anxiety (HADS-A ≥ 8) and depression (HADS-D ≥ 8) were found in 53.1% and 43.8% of the GTD group and 49.5% and 39.4% of the miscarriage group, with no difference between the groups. Severe symptoms of anxiety (HADS-A 15-21) and depression (HADS-D 15-21) were found, respectively, in 12.5% and 4.7% of the GTD group and in 9.1% and 4.0% of the miscarriage group, also with no difference between the groups. Lack of partner support proved a risk factor for anxiety and depression, while poor education increased the risk of depression symptoms 3.43-fold following pregnancy loss. In conclusion, three months after pregnancy loss the frequency of anxiety and depression symptoms was similarly high in both groups, with poor education and lack of partner support being significant risk factors for the subsequent development of psychiatric morbidity.
Collapse
Affiliation(s)
- Paula Jaeger Tenório
- Department of Comprehensive Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Leila Katz
- Department of Comprehensive Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Melania Maria Ramos Amorim
- Department of Comprehensive Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| |
Collapse
|
18
|
Whitburn J, Miah S, Howles SA. Pregnancy and parenthood in surgical training: a cross-sectional survey in the UK. Br J Surg 2023; 110:1628-1631. [PMID: 37463398 PMCID: PMC10638525 DOI: 10.1093/bjs/znad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Jessica Whitburn
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Saiful Miah
- Department of Urology, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Sarah A Howles
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Barbe C, Boiteux-Chabrier M, Charillon E, Bouazzi L, Maheas C, Merabet F, Graesslin O, Auer J, Hammami S, Rolland AC, Hurtaud A. Utility of early, short psychological care for women who experience early miscarriage: protocol for the randomized, controlled MisTher trial. BMC Psychol 2023; 11:368. [PMID: 37924101 PMCID: PMC10625184 DOI: 10.1186/s40359-023-01421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Around one in ten women will have a miscarriage in their lifetime. Miscarriage is often considered a trivial event by caregivers, but it is associated with a high burden of psychological morbidity, especially during the first 6 months. There is no validated psychological management strategy for women who have had a miscarriage. The MisTher study aims to evaluate the utility of early, short psychological care for women who have had early miscarriage, in terms of anxiety, depression and post-traumatic stress disorder. METHODS This is a prospective, multicenter, randomized, controlled, superiority study. In total, 932 women who have experienced early miscarriage (spontaneous interruption of pregnancy prior to 14 weeks of gestation) will be randomly assigned to either the intervention or the control group. The intervention consists of 4 teleconsultations of 45 min with a psychologist. All women, regardless of their allocated group, will be encouraged to seek an early consultation with a general practitioner or midwife. The primary endpoint will be anxiety at 3 months after randomization evaluated using State Trait Anxiety Inventory. The secondary endpoints will be anxiety at 6 months evaluated using State Trait Anxiety Inventory, depression at 3 and 6 months evaluated with the Beck Depression Inventory, and post-traumatic stress disorder at 3 and 6 months, evaluated using the Posttraumatic stress disorder Checklist Scale. DISCUSSION This project will validate the importance of early psychological management, based on primary care and accessible to most women, via teleconsultation, in reducing the frequency of psychological disorders after early miscarriage. Our results should provide a basis for new recommendations for the management of women who have experienced miscarriage, notably by recommending the involvement of trained psychologists in the management pathway for these women. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov: NCT05653414. December 15th, 2022.
Collapse
Affiliation(s)
- Coralie Barbe
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, Reims, France.
- Laboratoire C2S (Cognition, Santé, Société), EA6291, Université de Reims Champagne Ardenne, 51100, Reims, EA, France.
| | - Marie Boiteux-Chabrier
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, Reims, France
| | - Emilie Charillon
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, Reims, France
| | - Leïla Bouazzi
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, Reims, France
| | - Chloe Maheas
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, Reims, France
| | | | - Olivier Graesslin
- Service de Gynécologie et d'Obstétrique, Centre Hospitalier Universitaire de Reims, Avenue du Général Koenig, 51100, Reims, France
| | - Julie Auer
- Service de Psychothérapie de l'enfant et de l'adolescent, Pôle Femme-Parents-Enfant, Centre Hospitalier Universitaire de Reims, Avenue du Général Koenig, 51100, Reims, France
| | - Sabrina Hammami
- Laboratoire C2S (Cognition, Santé, Société), EA6291, Université de Reims Champagne Ardenne, 51100, Reims, EA, France
- Service de Psychothérapie de l'enfant et de l'adolescent, Pôle Femme-Parents-Enfant, Centre Hospitalier Universitaire de Reims, Avenue du Général Koenig, 51100, Reims, France
| | - Anne-Catherine Rolland
- Laboratoire C2S (Cognition, Santé, Société), EA6291, Université de Reims Champagne Ardenne, 51100, Reims, EA, France
- Service de Psychothérapie de l'enfant et de l'adolescent, Pôle Femme-Parents-Enfant, Centre Hospitalier Universitaire de Reims, Avenue du Général Koenig, 51100, Reims, France
| | - Aline Hurtaud
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, Reims, France
| |
Collapse
|
20
|
Bilardi JE, Temple-Smith M. We know all too well the significant psychological impact of miscarriage and recurrent miscarriage: so where is the support? Fertil Steril 2023; 120:937-939. [PMID: 37648144 DOI: 10.1016/j.fertnstert.2023.08.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
Miscarriage and recurrent miscarriage affect a significant proportion of every population with research consistently showing it results in profound and often prolonged psychological impacts. Despite the serious psychological impacts, support for miscarriage remains grossly inadequate. There are many ways to ameliorate the impact of these losses, which are not difficult, expensive, or time consuming. At a basic level, people want and need acknowledgment and validation of their grief and loss and greater information provision at the time of loss. A clear discrepancy also exists between the bereavement care offered by health care providers and the care wanted and needed by those affected, that must be addressed as a matter of urgency. At a health care system level, the collection of national miscarriage data must begin, to allow for a true understanding of the socioeconomic cost of miscarriage and the burden of early pregnancy loss on individuals, families, and our social systems. Furthermore, to direct research funding appropriately, establishing national research funding priorities for miscarriage support, as they have in the United Kingdom, is vital in assisting researchers and other key stakeholders to effectively target research in areas that are likely to have the greatest public health benefit. Consumers, health practitioners, and policymakers could achieve a lot for many with just a little commitment to change.
Collapse
Affiliation(s)
- Jade E Bilardi
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of General Practice, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia.
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| |
Collapse
|
21
|
Tancioco V, Pancholi R, Schechter-Perkins E, Drainoni ML, White K. Emergency department staff perspectives on caring for patients experiencing early pregnancy loss (Boston, Massachusetts 2021). Contraception 2023; 125:110091. [PMID: 37331465 DOI: 10.1016/j.contraception.2023.110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/28/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES A preimplementation study to examine the context of, and barriers and facilitators to, providing early pregnancy loss care in one emergency department (ED), to inform implementation strategies to improve ED-based early pregnancy loss care. STUDY DESIGN We recruited a purposive sample of participants and conducted semistructured individual qualitative interviews focused on caring for patients experiencing pregnancy loss in the ED until saturation was reached. For analysis, we used framework coding and directed content analysis. RESULTS Participant roles in the ED included administrators (N = 5), attending physicians (N = 5), resident physicians (N = 5), and registered nurses (N = 5). Most (70%, N = 14) participants identified as female. Primary themes included (1) caring for early pregnancy loss patients is challenging and uncomfortable, (2) inability to provide compassionate early pregnancy loss care causes moral injury, and (3) stigma influences early pregnancy loss care. Participants explained that early pregnancy loss is challenging due to added pressure, patient expectations, and gaps in knowledge. They reported barriers to providing compassionate care that are out of their control, such as systematic workflows, limited physical space, and insufficient time and expressed that these barriers lead to moral injury. Participants also reflected on how early pregnancy loss and abortion stigma affect patient care. CONCLUSIONS Caring for patients experiencing early pregnancy loss in the ED requires unique considerations. ED staff recognize this and desire more early pregnancy loss education, clearer early pregnancy loss tools and protocols, and early pregnancy loss-specific workflows. With concrete needs identified, an implementation plan to improve ED-based early pregnancy loss care can be created, which is important now more than ever, due to the impending influx in the ED for early pregnancy loss care after the Dobbs decision. IMPLICATIONS Since the Dobbs decision, patients are self-managing abortions and/or seeking out-of-state abortion care. Without access to follow-up, more patients are presenting to the ED with early pregnancy loss. By demonstrating the unique challenges emergency medicine clinicians face, this study can support initiatives to improve ED-based early pregnancy loss care.
Collapse
Affiliation(s)
- Virginia Tancioco
- Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
| | - Rushina Pancholi
- Obstetrics and Gynecology, Boston Medical Center, Boston, MA United States.
| | | | - Mari-Lynn Drainoni
- Sections of Infectious Diseases, Department of Medicine, Boston University/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States.
| | - Katharine White
- Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
| |
Collapse
|
22
|
Banwarth-Kuhn B, McQuade M, Krashin JW. Vaginal Bleeding Before 20 Weeks Gestation. Obstet Gynecol Clin North Am 2023; 50:473-492. [PMID: 37500211 DOI: 10.1016/j.ogc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Conditions that often present with vaginal bleeding before 20 weeks are common and can cause morbidity and mortality. Clinically stable patients can choose their management options. Clinically unstable patients require urgent procedural management: uterine aspiration, dilation and evacuation, or surgical removal of an ectopic pregnancy. Septic abortion requires prompt procedural management, intravenous antibiotics, and intravenous fluids. Available data on prognosis with expectant management of pre-viable rupture of membranes in the United States are poor for mothers and fetuses.
Collapse
Affiliation(s)
| | | | - Jamie W Krashin
- Department of Obstetrics & Gynecology, University of New Mexico Health Sciences Center, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
| |
Collapse
|
23
|
Galeotti M, Heaney S, Robinson M, Aventin Á. Evaluation of a pregnancy loss education intervention for undergraduate nursing students in Northern Ireland: A pre- and post-test study. BMC Nurs 2023; 22:268. [PMID: 37580730 PMCID: PMC10424365 DOI: 10.1186/s12912-023-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Research highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students. METHODS Educational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis. RESULTS 96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss. CONCLUSIONS The educational intervention increased student nurses' perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.
Collapse
Affiliation(s)
- Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Martin Robinson
- Stress, Trauma and Related Conditions Research Centre, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| |
Collapse
|
24
|
Li Y, Chau MHK, Zhang YX, Zhao Y, Xue S, Li TC, Cao Y, Dong Z, Choy KW, Chung JPW. A pilot investigation of low-pass genome sequencing identifying site-specific variation in chromosomal mosaicisms by a multiple site sampling approach in first-trimester miscarriages. Hum Reprod 2023; 38:1628-1642. [PMID: 37218343 DOI: 10.1093/humrep/dead090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
STUDY QUESTION Can multiple-site low-pass genome sequencing (GS) of products of conception (POCs) improve the detection of genetic abnormalities, especially heterogeneously distributed mosaicism and homogeneously distributed mosaicism in first-trimester miscarriage? SUMMARY ANSWER Multiple-site sampling combined with low-pass GS significantly increased genetic diagnostic yield (77.0%, 127/165) of first-trimester miscarriages, with mosaicisms accounting for 17.0% (28/165), especially heterogeneously distributed mosaicisms (75%, 21/28) that are currently underappreciated. WHAT IS KNOWN ALREADY Aneuploidies are well known to cause first-trimester miscarriage, which are detectable by conventional karyotyping and next-generation sequencing (NGS) on a single-site sampling basis. However, there are limited studies demonstrating the implications of mosaic genetic abnormalities in first-trimester miscarriages, especially when genetic heterogeneity is present in POCs. STUDY DESIGN, SIZE, DURATION This is a cross-sectional cohort study carried out at a university-affiliated public hospital. One hundred seventy-four patients diagnosed with first-trimester miscarriage from December 2018 to November 2021 were offered ultrasound-guided manual vacuum aspiration (USG-MVA) treatment. Products of conception were subjected to multiple-site low-pass GS for the detection of chromosomal imbalances. PARTICIPANTS/MATERIALS, SETTING, METHODS For each POC, multiple sites of villi (three sites on average) were biopsied for low-pass GS. Samples with maternal cell contamination (MCC) and polyploidy were excluded based on the quantitative fluorescence polymerase chain reaction (QF-PCR) results. The spectrum of chromosomal abnormalities, including mosaicism (heterogeneously distributed and homogeneously distributed) and constitutional abnormalities was investigated. Chromosomal microarray analysis and additional DNA fingerprinting were used for validation and MCC exclusion. A cross-platform comparison between conventional karyotyping and our multiple-site approach was also performed. MAIN RESULTS AND THE ROLE OF CHANCE One hundred sixty-five POCs (corresponding to 490 DNA samples) were subjected to low-pass GS. Genetic abnormalities were detected in 77.0% (127/165) of POCs by our novel approach. Specifically, 17.0% (28/165) of cases had either heterogeneously distributed mosaicism (12.7%, 21/165) or homogeneously distributed mosaicism (6.1%, 10/165) (three cases had both types of mosaicism). The remaining 60.0% (99/165) of cases had constitutional abnormalities. In addition, in the 71 cases with karyotyping performed in parallel, 26.8% (19/71) of the results could be revised by our approach. LIMITATIONS, REASONS FOR CAUTION Lack of a normal gestational week-matched cohort might hinder the establishment of a causative link between mosaicisms and first-trimester miscarriage. WIDER IMPLICATIONS OF THE FINDINGS Low-pass GS with multiple-site sampling increased the detection of chromosomal mosaicisms in first-trimester miscarriage POCs. This innovative multiple-site low-pass GS approach enabled the novel discovery of heterogeneously distributed mosaicism, which was prevalent in first-trimester miscarriage POCs and frequently observed in preimplantation embryos, but is currently unappreciated by conventional single-site cytogenetic investigations. STUDY FUNDING/COMPETING INTEREST(S) This work was supported partly by Research Grant Council Collaborative Research Fund (C4062-21GF to K.W.C), Science and Technology Projects in Guangzhou (202102010005 to K.W.C), Guangdong-Hong Kong Technology Cooperation Funding Scheme (TCFS), Innovation and Technology Fund (GHP/117/19GD to K.W.C), HKOG Direct Grant (2019.050 to J.P.W.C), and Hong Kong Health and Medical Research Fund (05160406 to J.P.W.C). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Ying Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Matthew Hoi Kin Chau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ying Xin Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center of Prenatal Diagnosis, Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yilin Zhao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shuwen Xue
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ye Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Zirui Dong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- The Chinese University of Hong Kong-Baylor College of Medicine Joint Center for Medical Genetics, Hong Kong, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
25
|
Heaney S, Galeotti M, Aventin Á. Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women's experiences of healthcare on the island of Ireland. BMC Pregnancy Childbirth 2023; 23:529. [PMID: 37480006 PMCID: PMC10360341 DOI: 10.1186/s12884-023-05839-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Losing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic. AIM To explore women's experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic. METHODS Findings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper. RESULTS Combined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals. CONCLUSIONS Women's experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.
Collapse
Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| |
Collapse
|
26
|
Koly KN, Saba J, Billah MA, McGirr A, Sarker T, Haque M, Mustary E, Hanifi SMMA, Begum F. Depressive symptoms and anxiety among women with a history of abortion living in urban slums of Bangladesh. BMC Psychol 2023; 11:197. [PMID: 37403178 DOI: 10.1186/s40359-023-01224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/16/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Globally, major emphasis has been placed on understanding the physiological consequences of losing a pregnancy. However, its mental health impact on socially disadvantaged women remains unexplored. To further inform the field the present study investigated the prevalence and factors associated with the development of depressive symptoms and anxiety among women with a history of spontaneous abortion living in the urban slums of Dhaka, Bangladesh. METHODS Information was obtained from 240 women who experienced a spontaneous abortion from July 2020 to December 2021. It was obtained through the urban health and demographic surveillance system (UHDSS) survey. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to measure mental health symptoms. Bivariate and multivariate linear regression analyses were performed to assess the associated factors with the mental health outcomes. RESULTS Of the 240 women, majority (77.50%) of the women experienced mild to severe depressive symptoms and more than half (58.75%) of the respondants experienced mild to severe anxiety, within one and half years of experiencing spontaneous abortion. A higher level of education and being employed were protective factors for anxiety and depressive symptoms, respectively. However, women with higher sexual and reproductive health rights (SRHR) knowledge had significantly increased anxiety and depressive symptoms. In contrast, receiving post-abortion care (PAC) was associated with decreased anxiety and depressive symptoms. CONCLUSION The findings indicate that ensuring access to affordable PAC services and integrating mental health services into the standard PAC service package is crucial. This study also emphasizes the importance of providing education for women living in urban slums and encouraging them to participate in economic activities.
Collapse
Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh.
| | - Jobaida Saba
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Md Arif Billah
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Alba McGirr
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Tithi Sarker
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - Mahbubul Haque
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - Elvina Mustary
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - S M Manzoor Ahmed Hanifi
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Farzana Begum
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| |
Collapse
|
27
|
Shapiro MO, Kroll-Desrosiers A, Mattocks KM. Understanding the Mental Health Impact of Previous Pregnancy Loss Among Currently Pregnant Veterans. Womens Health Issues 2023; 33:422-427. [PMID: 37100719 DOI: 10.1016/j.whi.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Pregnancy loss, including miscarriage and stillbirth, is common and associated with an increased risk for prenatal and postnatal depression, as well as posttraumatic stress disorder (PTSD). Racial disparities have been observed in pregnancy loss, with Black women having higher rates of pregnancy loss and postnatal depression. However, no research to date has examined the mental health and demographic correlates of pregnancy loss within a veteran population. METHOD The current study examined associations between pregnancy loss and mental health and demographic correlates among 1,324 pregnant veterans, of which 368 had a history of at least one stillbirth and/or miscarriage. RESULTS Veterans with a history of pregnancy loss, compared with those without, were more likely to have a diagnosis of anxiety (52.7% vs. 46.4%, p = .04), depression (62.5% vs. 50.8%, p = .0001), or PTSD (46.5% vs. 37.6%, p = .003); were more likely to report receiving mental health care during pregnancy (23.1% vs. 16.8%, p = .01); and were more likely to have experienced military sexual trauma (harassment: 56.5% vs. 49.9%, p = .04; rape: 38.9% vs. 29.3%, p = .0004). Results also indicated that Black veterans were more likely to report a history of pregnancy loss (32.1% vs. 25.3%, p = .01). Further, Black veterans were more likely to experience clinically meaningful prenatal depression symptoms (adjusted odds ratio: 1.90; 95% confidence interval: 1.42-2.54) after accounting for past loss and age in logistic regression models. DISCUSSION Taken together, findings from the present investigation corroborate previous research highlighting the deleterious impact of pregnancy loss and extend prior work by examining these associations among a diverse sample of pregnant veterans.
Collapse
Affiliation(s)
- Mary O Shapiro
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana; South Central Mental Illness Research, Education and Clinical Center; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| |
Collapse
|
28
|
Mendes DCG, Fonseca A, Cameirão MS. The psychological impact of Early Pregnancy Loss in Portugal: incidence and the effect on psychological morbidity. Front Public Health 2023; 11:1188060. [PMID: 37427267 PMCID: PMC10325666 DOI: 10.3389/fpubh.2023.1188060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Worldwide, up to a quarter of all recognized pregnancies result in Early Pregnancy Loss (EPL), also known as miscarriage. For many women, this is a traumatic experience that leads to persistent negative mental health responses. The most common morbidity reported in studies from different countries is complicated grief, usually comorbid with depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). To our best knowledge, no studies characterizing the psychological impact of EPL have been made in Portugal. Methods An online survey was conducted to evaluate clinical symptoms of perinatal grief, anxiety, depression, and PTSD in women who suffered a spontaneous loss within 20 weeks of gestation. Out of 1,015 women who answered this survey, 873 were considered eligible, and subsequently distributed in 7 groups according to the time passed between their loss and their participation in the study. Results The proportion of women showing symptoms of all comorbidities was greater in those whose loss had happened within a month, and there was a significant gradual decrease over time in scores and proportions of clinical perinatal grief and PTSD. In terms of depression symptoms, scores dropped significantly in the group whose loss occurred 13-24 months before their participation but proportions oscillated without great changes in the other groups. Regarding anxiety, there were small oscillations, but there was no significant decrease of symptoms over time. Discussion Overall, despite a general drop in scores for most morbidities over time, substantial proportions of women showed persistent symptoms of clinical morbidities 3 years or more after the loss. Therefore, it is essential to promote monitoring of possible complicated responses to the event, to provide appropriate and timely intervention to those women in need.
Collapse
Affiliation(s)
- Diana C. Gonçalves Mendes
- Faculdade de Ciências Exatas e da Engenharia & NOVA LINCS, Universidade da Madeira, Funchal, Portugal
- Agência Regional para o Desenvolvimento de Investigação, Tecnologia e Inovação (ARDITI), Funchal, Portugal
| | - Ana Fonseca
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
| | - Mónica S. Cameirão
- Faculdade de Ciências Exatas e da Engenharia & NOVA LINCS, Universidade da Madeira, Funchal, Portugal
- Agência Regional para o Desenvolvimento de Investigação, Tecnologia e Inovação (ARDITI), Funchal, Portugal
| |
Collapse
|
29
|
Inkster B, Kadaba M, Subramanian V. Understanding the impact of an AI-enabled conversational agent mobile app on users' mental health and wellbeing with a self-reported maternal event: a mixed method real-world data mHealth study. Front Glob Womens Health 2023; 4:1084302. [PMID: 37332481 PMCID: PMC10272556 DOI: 10.3389/fgwh.2023.1084302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA. Methods Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann-Whitney test (M-W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored. Results Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M-W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude. Conclusion These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.
Collapse
Affiliation(s)
- Becky Inkster
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Wysa Inc., Boston, MA, United States
| | | | | |
Collapse
|
30
|
Giakoni-Ramírez F, Godoy-Cumillaf A, Espoz-Lazo S, Duclos-Bastias D, Del Val Martín P. Physical Activity in Immersive Virtual Reality: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11111553. [PMID: 37297694 DOI: 10.3390/healthcare11111553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Physical activity has benefits for health, but many adolescents are inactive. However, video games such as Immersive Virtual Reality (IVR) have grown in popularity as a leisure activity among young people, allowing them to manipulate objects in virtual environments increasing the practice of physical activity. The evidence indicates that the interest in physical activity through IVR is greater than in traditional methods, and different experiences have been reported. However, few studies indicate the sample evaluated, the effects found, or the IVR instruments used. Due to this, is the aim of this study is to identify the publications referring to IVR and physical activity, characterize them, and present the obtained main findings. For this, the guidelines described in the PRISMA-ScR for scoping reviews were applied. After the use of the inclusion and exclusion criteria, eight articles were included. Results show evidence regarding physiological outcomes, perceptual variables, interest and enjoyment, and psychological effects regarding physical activity through IVR. Additionally, the use of different devices and their prescriptions are explored. It is concluded that there is interest from the scientific community for the practice of physical activity through IVR, as well as for its application for the maintenance of active habits. This is important as it positions IVR as a method that can be a more experiential and effective way to develop and maintain a healthy lifestyle.
Collapse
Affiliation(s)
- Frano Giakoni-Ramírez
- Faculty of Education and Social Sciences, Universidad Andres Bello, Las Condes, Santiago 7550000, Chile
| | - Andrés Godoy-Cumillaf
- Grupo de Investigación en Educación Física, Salud y Calidad de Vida, Facultad de Educación, Universidad Autónoma de Chile, Temuco 4780000, Chile
| | - Sebastián Espoz-Lazo
- Facultad de Ciencias Para el Cuidado de la Salud, Universidad San Sebastián, Sede Los Leones 5090660, Chile
| | - Daniel Duclos-Bastias
- Escuela de Educación Física, Pontificia Universidad Católica de Valparaíso, Valparaíso 2374631, Chile
- IGOID Research Group, Physical Activity and Sport Science Department, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Pablo Del Val Martín
- Faculty of Education and Social Sciences, Universidad Andres Bello, Las Condes, Santiago 7550000, Chile
| |
Collapse
|
31
|
Toutain T, Philip CA, Bollon L, Cros M, Fraissenon A, Dupont C, Gaucher L, Haesebaert J, Nohuz E, Cortet M. Surgical management of a loss of pregnancy in the first trimester: Patient experience and influencing factors, a prospective observational study. J Gynecol Obstet Hum Reprod 2023; 52:102602. [PMID: 37187317 DOI: 10.1016/j.jogoh.2023.102602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Describe the "patient experience" regarding care provided during the surgical management of a loss of pregnancy in the first trimester and identify the factors influencing this experience. MATERIAL AND METHODS It is an observational prospective study conducted in two type III, academic, maternity wards in Lyon, France, carrying out 8,500 deliveries per year. Adult female patients, having undergone a suction curettage for a loss of pregnancy in the first trimester from 24 December 2020 to 13 June 2021 were inculded. The "patient experience" was assessed using the 15 questions of the Picker Patient Experience (PPE-15) questionnaire, and research was conducted on factors influencing the patient experience. The main outcome was the percentage of patients reporting a problem in response to at least one of the PPE-15 questions. RESULTS 58 out of 79 patients (73% CI [62-83]) reported at least one problem with their care. The largest proportion of problems was raised in question about "Opportunity for family/loved ones to talk to the doctor" (76% CI [61-87]). The lowest proportion of problems was raised in question about "Treated with respect and dignity" (8% CI [3-16]). No factors influencing the patient experience were identified. DISCUSSION Almost three out of four patients reported a problem in the experience as a patient. The main areas of improvement reported by patients were the participation of their family/relatives and the emotional support provided by the healthcare team. TWEETABLE ABSTRACT Better communication with patient families and emotional support could improve patient experience during the surgical management of a loss of pregnancy in the first trimester.
Collapse
Affiliation(s)
- T Toutain
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France
| | - C-A Philip
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France
| | - L Bollon
- Faculty of Maieutic, Lyon, France
| | - M Cros
- Faculty of Maieutic, Lyon, France
| | - A Fraissenon
- Mother and Child Radiology Department, North University Hospital, Saint Etienne 42000, France; Paediatric Imaging Department, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - C Dupont
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; AURORE Perinatal Network, Lyon 69004, France
| | - L Gaucher
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Midwifery Department, Geneva, Switzerland; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - J Haesebaert
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - E Nohuz
- Department of Obstetrics and Gynaecology, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - M Cortet
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France.
| |
Collapse
|
32
|
Bilardi J, Webb A, Trieu VH, Sharp G, McIntosh J, Temple-Smith M. Miscarriage Australia: the use of a human centered design approach to design and develop a website for those affected by miscarriage. Front Public Health 2023; 11:1128768. [PMID: 37250069 PMCID: PMC10213628 DOI: 10.3389/fpubh.2023.1128768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background Past research has shown that Australians affected by miscarriage want a website specific to both miscarriage and their local region that is accessible, comprehensive, evidence-based and informed by experts. The aim of this study was to design, develop and evaluate the Miscarriage Australia website using human centered design. Methods A four stage human centered design approach was used to develop the Miscarriage Australia website which aimed to: (1) Understand the issue and why users need a website; (2) Define users' specific needs; (3) Design solutions to meet those needs; and (4) Evaluate the design by testing with end users. Across the four stages, various types of data and data analysis were developed and utilized including interviews, desktop research, development of personas and tone of voice, followed by usability testing. Process and content were guided by designers, developers and an expert advisory committee of key stakeholders. Results Analysis and synthesis of user research across Stages 1 and Stage 2 found 11 key themes pertaining to user's miscarriage experiences and support needs. Using the themes, common experiences, goals, motivations and behaviors of users were identified and similar user types grouped and used to inform the development of two personas. Using the personas and user research findings, design elements (Stage 3) including the "tone of voice guidelines" were developed recommending the Miscarriage Australia website be calm, empathetic, hopeful and authoritative. The tone of voice guidelines guided branding and over 100 pages of content was informed by the research team and reviewed by a 13-member Expert Clinical Advisory Committee over two rounds to ensure it was evidence based and reflected best practice. Using a contextual inquiry approach, usability testing was undertaken with 8 end users to test a low fidelity mockup and high-fidelity prototype of the website. Overall, end users reported the website was highly acceptable in terms of the design, content, layout, language and terminology, describing it in line with the intended tone of voice. Users reported the website was easy to use and navigate and provided useful and appropriate content and resources. Minor areas for improvement included slight changes to specific images, improved links for navigating sections, and a title change to one section heading. Conclusion The Miscarriage Australia website was successfully implemented and commended by users as meeting their needs. As a result of using human centered design, the Miscarriage Australia website provides an ideal template or blueprint on how to develop a successful and useful digital resource for users, particularly around sensitive women's health issues.
Collapse
Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Amy Webb
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Van-Hau Trieu
- Department of Information Systems and Business Analytics, Deakin University, Melbourne, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jennifer McIntosh
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- HumaniSE Lab, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
33
|
Vasconcelos S, Caniçais C, Chuva de Sousa Lopes SM, Marques CJ, Dória S. The role of DNA hydroxymethylation and TET enzymes in placental development and pregnancy outcome. Clin Epigenetics 2023; 15:66. [PMID: 37095555 PMCID: PMC10127343 DOI: 10.1186/s13148-023-01483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
The placenta is a temporary organ that is essential for supporting mammalian embryo and fetal development. Understanding the molecular mechanisms underlying trophoblast differentiation and placental function may contribute to improving the diagnosis and treatment of obstetric complications. Epigenetics plays a significant role in the regulation of gene expression, particularly at imprinted genes, which are fundamental in the control of placental development. The Ten-Eleven-Translocation enzymes are part of the epigenetic machinery, converting 5-methylcytosine (5mC) into 5-hydroxymethylcytosine (5hmC). DNA hydroxymethylation is thought to act as an intermediate in the DNA demethylation mechanism and potentially be a stable and functionally relevant epigenetic mark on its own. The role of DNA hydroxymethylation during differentiation and development of the placenta is not fully understood but increasing knowledge in this field will help to evaluate its potential role in pregnancy complications. This review focuses on DNA hydroxymethylation and its epigenetic regulators in human and mouse placental development and function. Additionally, we address 5hmC in the context of genomic imprinting mechanism and in pregnancy complications, such as intrauterine growth restriction, preeclampsia and pregnancy loss. The cumulative findings show that DNA hydroxymethylation might be important for the control of gene expression in the placenta and suggest a dynamic role in the differentiation of trophoblast cell types during gestation.
Collapse
Affiliation(s)
- Sara Vasconcelos
- Genetics Unit, Department of Pathology, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Carla Caniçais
- Genetics Unit, Department of Pathology, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Porto, Portugal
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | | | - C Joana Marques
- Genetics Unit, Department of Pathology, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
- i3S - Instituto de Investigação e Inovação em Saúde, Porto, Portugal.
| | - Sofia Dória
- Genetics Unit, Department of Pathology, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
- i3S - Instituto de Investigação e Inovação em Saúde, Porto, Portugal.
| |
Collapse
|
34
|
Burgess A, Murray C, Clancy A. Fathers' Relational Experiences of Stillbirth: Pre-natal Attachment, Loss and Continuing Bonds Through Use of Objects. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231162736. [PMID: 36927236 DOI: 10.1177/00302228231162736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study aimed to investigate fathers' lived experiences of stillbirth through the lens of continuing bonds and use of objects. Semi-structured interviews were conducted with six fathers who had experienced stillbirth from 20 weeks gestation. Interpretative phenomenological analysis revealed five themes: loss and continued bonds in a mother-mediated dynamic, objects as manifestations of relational and meaningful memories, exerting existence and continued connection to others, continued bond through physical presence and evolving expressions of love and fatherhood. Findings offer a novel understanding of the relationship between objects and continued bonds, where objects are seen to facilitate this bond through varying means, including physical manifestation of the deceased and representation of the father-infant relationship. The study places importance on fathers' involvement in creating objects permeated with meaning and memories, and of validating fathers' experiences of loss rather than considering these men merely as partners of a mother who lost their own baby.
Collapse
Affiliation(s)
- Amy Burgess
- Doctorate in Clinical Psychology, Lancaster University, UK
| | - Craig Murray
- Doctorate in Clinical Psychology, Lancaster University, UK
| | - Anna Clancy
- Doctorate in Clinical Psychology, Lancaster University, UK
- Aching Arms, Brentwood, UK
| |
Collapse
|
35
|
Lazarides C, Moog NK, Verner G, Voelkle MC, Henrich W, Heim CM, Braun T, Wadhwa PD, Buss C, Entringer S. The association between history of prenatal loss and maternal psychological state in a subsequent pregnancy: an ecological momentary assessment (EMA) study. Psychol Med 2023; 53:855-865. [PMID: 34127159 PMCID: PMC9975992 DOI: 10.1017/s0033291721002221] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prenatal loss which occurs in approximately 20% of pregnancies represents a well-established risk factor for anxiety and affective disorders. In the current study, we examined whether a history of prenatal loss is associated with a subsequent pregnancy with maternal psychological state using ecological momentary assessment (EMA)-based measures of pregnancy-specific distress and mood in everyday life. METHOD This study was conducted in a cohort of N = 155 healthy pregnant women, of which N = 40 had a history of prenatal loss. An EMA protocol was used in early and late pregnancy to collect repeated measures of maternal stress and mood, on average eight times per day over a consecutive 4-day period. The association between a history of prenatal loss and psychological state was estimated using linear mixed models. RESULTS Compared to women who had not experienced a prior prenatal loss, women with a history of prenatal loss reported higher levels of pregnancy-specific distress in early as well as late pregnancy and also were more nervous and tired. Furthermore, in the comparison group pregnancy-specific distress decreased and mood improved from early to late pregnancy, whereas these changes across pregnancy were not evident in women in the prenatal loss group. CONCLUSION Our findings suggest that prenatal loss in a prior pregnancy is associated with a subsequent pregnancy with significantly higher stress and impaired mood levels in everyday life across gestation. These findings have important implications for designing EMA-based ambulatory, personalized interventions to reduce stress during pregnancy in this high-risk group.
Collapse
Affiliation(s)
- Claudia Lazarides
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nora K. Moog
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Glenn Verner
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel C. Voelkle
- Faculty of Life Science, Department of Psychology, Psychological Research Methods, Humboldt-University of Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christine M. Heim
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thorsten Braun
- Department of Obstetrics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pathik D. Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
| | - Claudia Buss
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Sonja Entringer
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| |
Collapse
|
36
|
Yang X, Tian X, Liu H, Wang J, Wang F. Homocysteine increases uterine artery blood flow resistance in women with pregnancy loss. J Gynecol Obstet Hum Reprod 2023; 52:102533. [PMID: 36610604 DOI: 10.1016/j.jogoh.2023.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/08/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Uterine arterial blood flow is an important factor in embryonic development. Increased uterine artery blood flow resistance may be related to vascular damage. Homocysteine (HCY) can induce injury of endothelial through various pathways. Therefore, we investigate the association between serum HCY levels and uterine artery blood flow in the non-pregnant state in women who have experienced pregnancy loss (PL). METHODS 364 women eligible for PL were included in the study. The detection of HCY was completed by the Laboratory of Lanzhou University Second Hospital. We divided the patients into three groups: Low-HCY (HCY<10 umol/L, n = 144), Medium-HCY (HCY 10∼15 umol/L, n = 174) and High-HCY (HCY>15 umol/L, n = 46). The patients were subjected to vaginal color Doppler ultrasonography to measure bilateral uterine artery resistance index (RI), pulsatility index (PI) and peak systolic velocity/end diastolic velocity (S/D). RESULT Among 364 women, the right uterine artery RI in L-HCY, M-HCY, and H-HCY groups were 0.78±0.08, 0.79±0.07 and 0.81±0.07, respectively (P = 0.04). The left uterine artery RI in L-HCY, M-HCY, and H-HCY groups were 0.78±0.08, 0.81±0.07 and 0.81±0.07, respectively (P = 0.01). The right uterine artery RI level and the left uterine artery RI was significantly associated with HCY level (r = 0.103, P = 0.050; r = 0.104, P = 0.047, respectively). Of these, 177 women experienced their next pregnancy, and 33 patients experienced PL again. The pregnancy rate in l-HCY, M-HCY, and HHCY groups were 47.92% (69/144), 49.43% (86/174) and 47.83% (22/46), respectively (P = 0.95). In next pregnancy, the PL rate in l-HCY, M-HCY, and HHCY groups were 8.70% (6/69), 22.58% (22/86) and 22.73% (5/22), respectively (P = 0.03). CONCLUSION HCY can increase the uterine artery resistance in the non-pregnant state and is associated with the abortion rate of next pregnancy.
Collapse
Affiliation(s)
- Xin Yang
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China
| | - Xiuli Tian
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China
| | - Haoxin Liu
- College of LSA, University of Michigan, Ann Arbor, MI 48109, United States
| | - Juan Wang
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China
| | - Fang Wang
- Reproductive Medicine Center, Second Hospital of Lanzhou University, No.82, Cuiying Road, Chengguan District, Lanzhou, Gansu 730030, China.
| |
Collapse
|
37
|
Ansiedade materna e sua interferência na autoeficácia para amamentação. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao02301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
38
|
Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Wischmann T, Kuon RJ. The Posttraumatic Impact of Recurrent Pregnancy Loss in Both Women and Men. Geburtshilfe Frauenheilkd 2023; 83:88-96. [PMID: 36643876 PMCID: PMC9835763 DOI: 10.1055/a-1916-9180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Recurrent pregnancy loss is usually associated with significant psychological distress for both partners of the couple. It may act as a traumatic experience resulting in a posttraumatic stress disorder. The object of this study is to examine the posttraumatic impact of recurrent pregnancy loss on men and women and their interdependencies. Methods Cross-sectional study. All couples referred to the special unit for recurrent pregnancy loss between March 2019 and October 2020 were asked to participate with a sample size of 105 couples and 17 women. They were invited to complete a questionnaire package estimating the prevalence of posttraumatic stress, with anxiety, depression, lack of social support and dysfunctional coping strategies as contributing risk factors. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as a dyad. Results The response rate was 82.3 percent, with posttraumatic stress being measured in 13.7% of the women versus 3.9% of the men (p = 0.017). For women, number of curettages, controlled for the number of losses, correlated with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and lack of social support in women correlated positively with posttraumatic stress in their partners. The men's coping strategy "trivialization and wishful thinking" as well as "avoidance" correlated with more severe posttraumatic stress in the female partners (both p < 0.05). Conclusion The posttraumatic risks within a couple with recurrent pregnancy loss are interdependent. Recurrent pregnancy loss clinics should assess posttraumatic risks of both partners in their routine diagnostic process.
Collapse
Affiliation(s)
- Emily Kuhlmann
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Pauline Scharli
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Laila Langer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Ruben-J. Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Korrespondenzadresse Prof. Dr. Ruben-J. Kuon Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s HospitalIm Neuenheimer Feld 44069120 HeidelbergGermany
| |
Collapse
|
39
|
Duane M, Schliep K, Porucznik CA, Najmabadi S, Stanford JB. Does a short luteal phase correlate with an increased risk of miscarriage? A cohort study. BMC Pregnancy Childbirth 2022; 22:922. [PMID: 36482355 PMCID: PMC9733331 DOI: 10.1186/s12884-022-05195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Miscarriage is defined as spontaneous loss of pregnancy prior to 20 weeks gestation. With an estimated risk of 15% of clinically confirmed pregnancies ending in miscarriage, it is the most common adverse event in pregnancy. Woman's age is the primary risk factor for miscarriage, while medical conditions, including hormonal abnormalities, are also associated. Progesterone is essential for maintaining pregnancy. A short luteal phase may reflect inadequate levels of progesterone production, but it is unclear whether a short luteal phase correlates with an increase in the risk of miscarriage. METHODS Using a cohort study design, we conducted a secondary data analysis from four cohorts of couples who used a standardized protocol to track biomarkers of the female cycles. A short luteal phase was defined as less than 10 days, with < 11, < 9, and < 8 days as alternate definitions in sensitivity analyses. We included women who experienced a pregnancy with a known outcome, identified the length of the luteal phase in up to 3 cycles prior to conception and assessed the relationship with miscarriage using a modified Poisson regression analysis, adjusting for demographic characteristics, smoking, alcohol use and previous pregnancy history. RESULTS In our sample of 252 women; the overall miscarriage rate was 18.7%. The adjusted incident risk ratio of miscarriage in women who had at least one short luteal phase < 10 days, compared to those who had none, was 1.01 (95% CI: 0.57, 1.80) Similar null risk was found when assessing alternative lengths of short luteal phase. Women who had short luteal phases < 10 days in all 3 cycles prior to the conception cycle had an incident risk ratio of 2.14 (95% CI: 0.7, 6.55). CONCLUSIONS Our study found that a short luteal phase in the three cycles prior to conception was not associated with higher rates of miscarriage in an international cohort of women tracking their cycles, but our sample size was limited. Further research to determine if short luteal phases or luteal phase deficiency is associated with early pregnancy losses among preconception cohorts with daily tracking of cycle parameters, in addition to progesterone and human chorionic gonadotropin levels, is warranted. Additionally, future studies should include women with recurrent short luteal phases as a more likely risk factor than isolated short luteal phases.
Collapse
Affiliation(s)
- Marguerite Duane
- Department of Family Medicine, Georgetown University, Washington, DC, USA.
- Executive Director, Fertility Appreciation Collaborative to Teach the Science (FACTS), Lancaster, PA, USA.
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Karen Schliep
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Christina A Porucznik
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Shahpar Najmabadi
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joseph B Stanford
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
40
|
Hu KL, Chen Z, Deng W, Li X, Ju L, Yang H, Zhang H, Mu L. Diagnostic Value of Kisspeptin Levels on Early Pregnancy Outcome: a Systematic Review and Meta-analysis. Reprod Sci 2022; 29:3365-3372. [PMID: 35212930 DOI: 10.1007/s43032-022-00856-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/09/2022] [Indexed: 12/14/2022]
Abstract
The objective of this study is to investigate whether kisspeptin levels in early pregnancy have a better diagnostic value on early pregnancy outcome as compared with human chorionic gonadotropin (hCG). This study was a systematic review and meta-analysis aiming to investigate the diagnostic value of kisspeptin levels on early pregnancy outcome. The primary outcome was miscarriage or viable intrauterine pregnancy. Five studies were included for systematic review, and three studies were included for meta-analysis. Meta-analysis showed kisspeptin levels had a good diagnostic value with the area under the curve (AUC) 0.902 (0.866, 0.937) when kisspeptin was measured after 6 weeks of gestation. Sensitivity analysis demonstrated kisspeptin levels had a diagnostic value with AUC = 0.881 (0.855, 0.906). hCG levels had a diagnostic value with AUC = 0.834 (0.785, 0.883), which was inferior to the diagnostic value of kisspeptin (mean difference = 0.09 (0.02, 0.16)). Kisspeptin measurement has a potential for comparable or even higher accuracy than hCG in differentiating between miscarriage and viable intrauterine pregnancy after 6 weeks of gestation.
Collapse
Affiliation(s)
- Kai-Lun Hu
- Center for Reproductive Medicine, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, People's Republic of China, 100191
- Zhejiang MedicalTech Therapeutics Company, No.665 Yumeng Road, Wenzhou, People's Republic of China, 325200
| | - Zimiao Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China, 325000
| | - Wenhai Deng
- Zhejiang MedicalTech Therapeutics Company, No.665 Yumeng Road, Wenzhou, People's Republic of China, 325200
| | - Xiaoxue Li
- Zhejiang MedicalTech Therapeutics Company, No.665 Yumeng Road, Wenzhou, People's Republic of China, 325200
| | - Liping Ju
- Zhejiang MedicalTech Therapeutics Company, No.665 Yumeng Road, Wenzhou, People's Republic of China, 325200
| | - Haiyan Yang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China, 325000
| | - Hong Zhang
- Medical Reproductive Center, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, People's Republic of China, 215026.
| | - Liangshan Mu
- Zhejiang MedicalTech Therapeutics Company, No.665 Yumeng Road, Wenzhou, People's Republic of China, 325200.
| |
Collapse
|
41
|
Gavrizi S, Pike J, Mak W. Understanding the Needs of Individuals Who Have Experienced Pregnancy Loss: A Retrospective Community-Based Survey. J Womens Health (Larchmt) 2022; 31:1805-1811. [PMID: 33646020 DOI: 10.1089/jwh.2020.8747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Pregnancy loss is the most common complication of pregnancy and understanding the needs of individuals experiencing pregnancy loss will help the medical team provide patient-centered care. Few studies address differences in needs of individuals regarding timing of pregnancy losses and number of losses. Methods: An anonymous nine-question survey assessing the experience and immediate needs of individuals who have had pregnancy loss. Results: The survey response was high (79%; 793/1000). 75.8% of the respondents experienced first trimester losses, and 55.0% experienced more than one pregnancy loss. Respondents with three or more losses were more likely to see a reproductive endocrinologist compared to those experiencing one loss (15.7% vs. 6.4%, p < 0.01). The highest-ranked need among all respondents (45.5%) was understanding why their pregnancy loss occurred followed by family support (26.8%). However, those who had more than three losses or first trimester losses ranked preventing a future pregnancy loss over family support. Respondents with three or more losses more frequently desired a referral to a pregnancy loss team (37.5% vs. 79.7%, p < 0.001). A qualitative analysis of respondents' comments on how to provide patient-centered care revealed five major themes; the most frequently mentioned theme was staff preparedness, competence, and availability. Conclusion: Our survey highlights the overwhelming importance to individuals who have had pregnancy loss of finding a cause for their loss, regardless of gestational age/multiple losses. Referral to a dedicated pregnancy loss provider/team is highly desired. Finally, patients value sensitivity, compassion, and emotional support from their physicians and their staff.
Collapse
Affiliation(s)
- Sarah Gavrizi
- Department of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jordyn Pike
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Texas, USA.,Texas Advanced Computing Center, The University of Texas at Austin, Texas, USA
| | - Winifred Mak
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| |
Collapse
|
42
|
Posttraumatic Stress Disorder Symptoms and Related Factors in Women with Early Pregnancy Loss. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1165862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim: Women may experience emotions such as fear, anxiety, stress, anger or guilt after pregnancy loss, and it can lead to posttraumatic stress disorder if the women cannot cope with these emotions. This study aimed to identify posttraumatic stress disorder symptoms and related factors in women with early pregnancy loss.
Material and Methods: The sample of this descriptive study consisted of 132 women hospitalised with early pregnancy loss in an Obstetrics and Gynecology service of a state hospital (
Collapse
|
43
|
Toth B, Bohlmann M, Hancke K, Kuon R, Nawroth F, von Otte S, Rogenhofer N, Rudnik-Schöneborn S, Schleußner E, Tempfer C, Vomstein K, Wischmann T, von Wolff M, Würfel W, Zschocke J. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022). Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1895-9940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Purpose The aim of this guideline is to standardize the diagnosis and therapy of recurrent miscarriage (RM) using evidence from the recent literature. This is done by using
consistent definitions, objective evaluations and standardized treatment protocols.
Methods When this guideline was compiled, special consideration was given to previous recommendations in prior versions of this guideline and the recommendations of the European
Society of Human Reproduction and Embryology, the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Society for
Reproductive Medicine, and a detailed individual search of the literature about the different topics was carried out.
Recommendations Recommendations about the diagnostic and therapeutic procedures offered to couples with RM were developed based on the international literature. Special attention was
paid to known risk factors such as chromosomal, anatomical, endocrinological, physiological coagulation, psychological, infectious and immune disorders. Recommendations were also developed
for those cases where investigations are unable to find any abnormality (idiopathic RM).
Collapse
Affiliation(s)
- Bettina Toth
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabeth Krankenhaus Lörrach, Lörrach, Germany
| | - Katharina Hancke
- Klinik für Frauenheilkunde, Universitätsklinikum Ulm, Ulm, Germany
| | - Ruben Kuon
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
| | | | - Sören von Otte
- Kinderwunschzentrum, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nina Rogenhofer
- Klinikum der Universität München – Frauenklinik Maistraße, München, Germany
| | | | | | - Clemens Tempfer
- Universitätsfrauenklinik, Ruhr-Universität Bochum, Bochum, Germany
| | - Kilian Vomstein
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Tewes Wischmann
- Institut für Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Johannes Zschocke
- Zentrum für Medizinische Genetik, Universität Innsbruck, Innsbruck, Austria
| |
Collapse
|
44
|
Levy S, Avitsur R. Gender Differences in the Development of Posttraumatic Stress Symptoms Following Pregnancy Loss: Social Support and Causal Attributes. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
45
|
Skogsdal Y, Karlsson J, Tydén T, Patil S, Backman H. The association of smoking, use of snuff, and preconception alcohol consumption with spontaneous abortion: A population-based cohort study. Acta Obstet Gynecol Scand 2022; 102:15-24. [PMID: 36222196 PMCID: PMC9780718 DOI: 10.1111/aogs.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION It is unclear whether tobacco in early pregnancy and alcohol use preceding pregnancy are associated with spontaneous abortion. The purpose was to investigate if use of tobacco and/or alcohol is associated with spontaneous abortion among women attending antenatal care, and if age and body mass index (BMI) attenuate the risk. MATERIAL AND METHODS A population-based cohort study based on data from the Swedish Pregnancy Register. All pregnant women having had the first antenatal visit from January 2014 to July 2018 were included (n = 525 604). The register had information about smoking and use of snuff before and in early pregnancy, as well as data on alcohol habits before pregnancy, measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated questionnaire. Logistic regression analysis was used to estimate the association between lifestyle factors and spontaneous abortion, and multiple imputation was used to impute missing data. RESULTS In total, 34 867 (6.6%) pregnancies ended in a spontaneous abortion after the first visit to maternal health care. At the first maternal healthcare visit, daily smoking was reported by 24 214 (5.1%), and 6403 (1.2%) used snuff. For 19 837 (4.2%) women, a high alcohol score was reported for the year preceding pregnancy. After adjusting for potential confounders and multiple imputation, use of tobacco was associated with spontaneous abortion; smoking 1-9 cigarettes/day (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.04-1.18), smoking 10 or more cigarettes/day (aOR 1.12, 95% CI 1.-1.26), and use of snuff (aOR 1.20, 95% CI 1.06-1.37). Higher AUDIT scores were not significantly associated with spontaneous abortion (AUDIT 6-9: aOR 1.03, 95% CI 0.97-1.10 and AUDIT 10 or more: aOR 1.07, 95% CI 0.94-1.22). Increasing maternal age showed the highest risk of spontaneous abortion from the age of 35, and BMI of 30 kg/m2 or more increased the risk. There were interactions between different lifestyle factors associated with spontaneous abortion that could either increase or decrease the risk of spontaneous abortion. CONCLUSIONS Smoking and use of snuff were associated with an increased risk of spontaneous abortion. The AUDIT scores preceding pregnancy were not associated with an increased risk of spontaneous abortion, which contradicts the results from previous studies.
Collapse
Affiliation(s)
- Yvonne Skogsdal
- Maternal Health Care Unit, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Jan Karlsson
- University Health Care Research CenterFaculty of Medicine and Health, Örebro UniversityÖrebroSweden
| | - Tanja Tydén
- Department of Women's and Children's HealthAkademiska SjukhusetUppsalaSweden
| | - Snehal Patil
- Clinical Epidemiology and Biostatistics, School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| |
Collapse
|
46
|
Outdoor Air Pollution and Pregnancy Loss: a Review of Recent Literature. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose of Review
This review summarizes recent literature about the impacts of outdoor air pollution on pregnancy loss (spontaneous abortion/miscarriage and stillbirth), identifies challenges and opportunities, and provides recommendations for actions.
Recent Findings
Both short- and long-term exposures to ubiquitous air pollutants, including fine particulate matter < 2.5 and < 10 μm, may increase pregnancy loss risk. Windows of susceptibility include the entire gestational period, especially early pregnancy, and the week before event. Vulnerable subpopulations were not consistently explored, but some evidence suggests that pregnant parents from more disadvantaged populations may be more impacted even at the same exposure level.
Summary
Given environmental conditions conductive to high air pollution exposures become more prevalent as the climate shifts, air pollution’s impacts on pregnancy is expected to become a growing public health concern. While awaiting larger preconception studies to further understand causal impacts, multi-disciplinary efforts to minimize exposures among pregnant women are warranted.
Collapse
|
47
|
Automated prediction of early spontaneous miscarriage based on the analyzing ultrasonographic gestational sac imaging by the convolutional neural network: a case-control and cohort study. BMC Pregnancy Childbirth 2022; 22:621. [PMID: 35932003 PMCID: PMC9354356 DOI: 10.1186/s12884-022-04936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background It is challenging to predict the outcome of the pregnancy when fetal heart activity is detected in early pregnancy. However, an accurate prediction is of importance for obstetricians as it helps to provide appropriate consultancy and determine the frequency of ultrasound examinations. The purpose of this study was to investigate the role of the convolutional neural network (CNN) in the prediction of spontaneous miscarriage risk through the analysis of early ultrasound gestational sac images. Methods A total of 2196 ultrasound images from 1098 women with early singleton pregnancies of gestational age between 6 and 8 weeks were used for training a CNN for the prediction of the miscarriage in the retrospective study. The patients who had positive fetal cardiac activity on their first ultrasound but then experienced a miscarriage were enrolled. The control group was randomly selected in the same database from the fetuses confirmed to be normal during follow-up. Diagnostic performance of the algorithm was validated and tested in two separate test sets of 136 patients with 272 images, respectively. Performance in prediction of the miscarriage was compared between the CNN and the manual measurement of ultrasound characteristics in the prospective study. Results The accuracy of the predictive model was 80.32% and 78.1% in the retrospective and prospective study, respectively. The area under the receiver operating characteristic curve (AUC) for classification was 0.857 (95% confidence interval [CI], 0.793–0.922) in the retrospective study and 0.885 (95%CI, 0.846–0.925) in the prospective study, respectively. Correspondingly, the predictive power of the CNN was higher compared with manual ultrasound characteristics, for which the AUCs of the crown-rump length combined with fetal heart rate was 0.687 (95%CI, 0.587–0.775). Conclusions The CNN model showed high accuracy for predicting miscarriage through the analysis of early pregnancy ultrasound images and achieved better performance than that of manual measurement. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04936-0.
Collapse
|
48
|
Jansen C, Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Kuon RJ, Wischmann T. “A sorrow shared …”: a qualitative content analysis of what couples with recurrent miscarriages expect from one another and their families and friends. Hum Reprod Open 2022; 2022:hoac032. [PMID: 35928048 PMCID: PMC9345061 DOI: 10.1093/hropen/hoac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
STUDY QUESTION When couples have to face recurrent pregnancy loss (RPL), what are the partners’ wishes and needs and what is their perception of helpful and unhelpful factors with regard to their own, their partners’ and their families’ and friends’ ways of dealing with the problem? SUMMARY ANSWER Women and men with repeated miscarriages want open communication about their losses, but expect a sensitive and empathetic attitude from others, not pity or trivialization. WHAT IS KNOWN ALREADY RPL not only causes the women affected and their partners considerable emotional distress; it also has an impact on the couples’ relationships and the way they relate to their families and friends. Studies suggest that women have a greater need than their male partners to talk about their losses and that these differences may lead to dissatisfaction and cause relational tension. In addition, men often assume a ‘mainstay’ role, supporting their partners and displaying fortitude in the face of distress. As yet, however, little research has been conducted so far on the question of what the members of couples with RPL expect from one another and from their families and friends. STUDY DESIGN, SIZE, DURATION The study sample consisted of 147 couples and 17 women with at least 2 miscarriages attending the special unit for RPL at the University Women’s Hospital in Heidelberg (Germany) for the first time between September 2018 and October 2020 (response rate: 82.7%). The patients were asked to participate in this combined qualitative and questionnaire study. PARTICIPANTS/MATERIALS, SETTING, METHODS In order to explore the wishes and needs of those affected in more detail, the free text responses obtained were examined in this study by using qualitative content analysis. Categories and subcategories were created inductively to summarize and systematize content. MAIN RESULTS AND THE ROLE OF CHANCE Patients affected by RPL want their partners and their families and friends to deal with the topic openly and empathically. In the partnership itself, acceptance of individual grieving modes and sharing a common goal are important factors. Men, in particular, want their partners to be optimistic in facing up to the situation. Regarding communication with family and friends, it transpired that ‘good advice’, playing the matter down, inquiries about family planning, pity and special treatment are explicitly not appreciated. LIMITATIONS, REASONS FOR CAUTION The sample was a convenience sample, so self-selection effects cannot be excluded. In addition, the level of education in the sample was above average. Accordingly, the sample cannot be regarded as representative. The results of the content analysis are based on the respondents’ written answers to open-ended questions in the questionnaire. Unlike qualitative interview studies, further questioning was not possible in the case of ambiguities or to request more details. WIDER IMPLICATIONS OF THE FINDINGS Frank and sincere communication about miscarriages and about one’s own emotions and needs should be promoted both in the partnership and among family members and friends in order to strengthen the potential of social support as a resource. Open communication about the different needs of both partners is necessary to create mutual understanding. The results show the importance not only of empathy and consideration for the couples concerned but also their desire not to be pitied. Striking a fine balance between fellow-feeling and pity may also lead to tension, and this potential dilemma should be addressed in psychosocial counselling. Overall, the study contributes to a better understanding of what couples want from their families and friends when they are attempting to come to terms with RPL and highlights potential challenges in the interaction between affected couples and their families and friends. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. None of the authors declared any conflicts of interest. TRIAL REGISTRATION NUMBER DRKS00014965.
Collapse
Affiliation(s)
- C Jansen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
| | - E Kuhlmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - P Scharli
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - M Schick
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- University of Heidelberg , Heidelberg, Germany
| | - B Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
- University of Heidelberg , Heidelberg, Germany
| | - L Langer
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - T Strowitzki
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - R -J Kuon
- Heidelberg University Women’s Hospital Department of Gynaecological Endocrinology and Fertility Disorders, , Germany
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital Heidelberg , Germany
| |
Collapse
|
49
|
Bagkou Dimakou D, Tamblyn J, Justin C, Coomarasamy A, Richter A. Diagnosis and management of idiopathic recurrent pregnancy loss (RPL): Current immune testing and immunomodulatory treatment practice in the United Kingdom. J Reprod Immunol 2022; 153:103662. [PMID: 35872373 DOI: 10.1016/j.jri.2022.103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/01/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
Recurrent pregnancy loss (RPL) affects 1.9 % of couples. Despite the severe physical, psychological, and economic impact of RPL, miscarriage care provision remains highly heterogeneous. Due to the absence of strong scientific evidence, national and international guidelines on the diagnosis and treatment of this condition remain unclear and often contradictory. In the absence of identifiable RPL-associated risk factors, when the condition is termed "idiopathic", immunological tests and immunomodulatory treatments are sometimes suggested even though the contribution of aberrant immune activity to this condition remains undetermined. Through an online survey, distributed across the UK (37.7% response rate), a high variation in clinical practice was detected, with multiple RPL definitions utilized and different tests employed for potential risk factor identification. Immunological testing was found to be provided in 7.9 %(N = 3) of the included clinics. Moreover, multiple therapies, including immunomodulatory ones were utilized for the management of idiopathic RPL. These findings highlight a need for additional research on the implication of immune activity in this condition. The high variation between clinics regarding the tests employed for the diagnosis and management of idiopathic RPL also underlines the need for guidelines to direct clinical practice, taking into consideration both the patients' needs but also the strength of the available scientific evidence.
Collapse
Affiliation(s)
- Danai Bagkou Dimakou
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom; Tommy's National Centre for Miscarriage Research, United Kingdom.
| | - Jennifer Tamblyn
- Tommy's National Centre for Miscarriage Research, United Kingdom; Leeds General Teaching Hospital Trust, United Kingdom
| | - Chu Justin
- Tommy's National Centre for Miscarriage Research, United Kingdom; University of Birmingham, Institute of Metabolism and Systems Research, United Kingdom
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, United Kingdom; University of Birmingham, Institute of Metabolism and Systems Research, United Kingdom
| | - Alex Richter
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom
| |
Collapse
|
50
|
Dennis CL, Brown HK, Brennenstuhl S, Vigod S, Miller A, Castro RA, Marini FC, Birken C. Preconception risk factors and health care needs of pregnancy-planning women and men with a lifetime history or current mental illness: A nationwide survey. PLoS One 2022; 17:e0270158. [PMID: 35731809 PMCID: PMC9216596 DOI: 10.1371/journal.pone.0270158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/05/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives While depression and anxiety are common in women and men of reproductive age, preconception interventions to optimize the health of individuals with mental illness before pregnancy is limited and focuses primarily on psychotropic medication management. Comparing individuals with depression, anxiety, and comorbidity to those with neither condition, we identified areas of preconception care optimization related to psychosocial risk factors, general physical health, medication use, and uptake of high-risk health behaviours. We also investigated differences in preconception health care use, attitudes, and knowledge. Method We conducted a nationwide survey of 621 women (n = 529) and men (n = 92) across Canada who were planning a pregnancy within five years, including those with lifetime or current depression (n = 38), anxiety (n = 55), and comorbidity (n = 104) and those without mental illness (n = 413). Individuals with depression, anxiety, and comorbidity were compared to individuals without mental illness using logistic regression, adjusted for age, sex, and education level. Results Individuals with a lifetime or current mental illness were significantly more likely to have several risk factors for suboptimal reproductive and perinatal outcomes, including increased rates of obesity, stress, fatigue, loneliness, number of chronic health conditions, and medication use. Further, they were more likely to have high-risk health behaviours including increased substance use, internet addiction, poorer eating habits, and decreased physical activity. By assessing depression, anxiety, or both separately, we also determined there was variation in risk factors by mental illness type. Conclusion Our nationwide study is one of the first and largest to examine the preconception care needs of women and men with a lifetime or current mental illness who are pregnancy-planning. We found this population has many important reproductive and perinatal risk factors that are modifiable via preconception interventions which could have a significant positive impact on their health trajectories and those of their future children.
Collapse
Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Ainsley Miller
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | | | | | - Catherine Birken
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|